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1275 W 47th Pl Ste 306 Hialeah FL 33012-3447 | |
| (786) 399-0683 | |
| (305) 238-7233 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1275 W 47th Pl Ste 306, Hialeah, Florida |
| Authorized Official Name and Position | Dennis Marzo (PRESIDENT) |
| Authorized Official Contact | 7863990683 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1275 W 47th Pl Ste 305 Hialeah FL 33012-3447 Ph: (786) 399-0683 | 1275 W 47th Pl Ste 306 Hialeah FL 33012-3447 Ph: (786) 399-0683 |
| NPI Number | 1407326630 |
|---|---|
| Provider Enumeration Date | 11/30/2018 |
| Last Update Date | 07/15/2021 |
| Certification Date | 07/15/2021 |
| Medicare PECOS PAC ID | 9133508856 |
|---|---|
| Medicare Enrollment ID | O20220627000028 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407326630 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Ana M Villaverde |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447411558 PECOS PAC ID: 0547321515 Enrollment ID: I20081209000515 |
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